Table 304-2 Clinical and Epidemiologic Features of Viral Hepatitis

Feature

HAV

HBV

HCV

HDV

HEV

Incubation (days) 1545, mean

30

30180, mean 6090

15160, mean 50

30180, mean 6090 1460, mean

40

Onset

Acute

Insidious or acute

Insidious

Insidious or acute

Acute

Age preference

Children,
young adults

Young adults (sexual and

percutaneous), babies,
toddlers

Any age, but more

common in adults

Any age (similar to

HBV)

Young adults
(2040 years)

Fecal-oral

+++

+++

Percutaneous

Unusual

+++

+++

+++

Perinatal

+++

Transmission

Feature

HAV

HBV

HCV

HDV

HEV

Sexual

++

++

Severity

Mild

Occasionally severe

Moderate

Occasionally severe

Mild

Fulminant

0.1%

0.11%

0.1%

520%b

12%e

Progression to
chronicity

None

Occasional (110%) (90% of Common (85%)

neonates)

Commond

None

Carrier

None

0.130%c

Variablef

None

Cancer

None

+(Neonatal infection)

None

Prognosis

Excellent

Worse with age, debility

Clinical

1.53.2%
+

Moderate

Acute, good Chronic, Good

Feature

HAV

HBV

HCV

HDV

HEV

poor

Prophylaxis

IG, inactivated HBIG, recombinant vaccine

vaccine

None

HBV vaccine (none

for HBV carriers)

Vaccine

Therapy

None

Pegylated interferon plus

ribavirin telaprevir
boceprevir

Interferon

None

Interferon
Lamivudine
Adefovir
Pegylated interferon
Entecavir
Telbivudine
Tenofovir

Table 304-6 Simplified Diagnostic Approach in Patients Presenting with Acute Hepatitis

Serologic Tests of Patient's Serum

HBsAg

IgM Anti-HAV

IgM Anti-HBc

Anti-HCV

Diagnostic Interpretation

Acute hepatitis B

Chronic hepatitis B

Serologic Tests of Patient's Serum

Acute hepatitis A superimposed on chronic hepatitis B

Acute hepatitis A and B

Acute hepatitis A

Acute hepatitis A and B (HBsAg below detection threshold)

Acute hepatitis B (HBsAg below detection threshold)

Acute hepatitis C

Table 304-1 Nomenclature and Features of Hepatitis Viruses

Hepatitis Virus
Morphology
Type
Particle,
nm

Genome*

HAV

7.5-kb
Hepatovirus
RNA,
linear, ss, +

27

Icosahedral
nonenveloped

Classification

Antigen(s) Antibodies Remarks

HAV

Anti-HAV Early fecal shedding

Diagnosis: IgM anti-HAV
Previous infection: IgG anti-HAV

HBV

42

Double-shelled
3.2-kb
virion (surface and DNA,
core) spherical
circular,
ss/ds

Hepadnavirus

HBsAg

Anti-HBs

Bloodborne virus; carrier state

HBcAg

Anti-HBc

Acute diagnosis: HBsAg, IgM antiHBc

HBeAg

Anti-HBe
Chronic diagnosis: IgG anti-HBc,

Hepatitis Virus
Morphology
Type
Particle,
nm

Genome*

Classification

Antigen(s) Antibodies Remarks

HBsAg
Markers of replication: HBeAg,
HBV DNA
Liver, lymphocytes, other organs

27

22

Nucleocapsid core

Spherical and
filamentous;
represents excess
virus coat material

HBcAg

Anti-HBc

HBeAg

Anti-HBe

HBsAg

Anti-HBs

Nucleocapsid contains DNA and

DNA polymerase; present in
hepatocyte nucleus; HBcAg does
not circulate; HBeAg (soluble,
nonparticulate) and HBV DNA
circulatecorrelate with
infectivity and complete virions

HBsAg detectable in >95% of

patients with acute hepatitis B;
found in serum, body fluids,
hepatocyte cytoplasm; anti-HBs
appears following infection
protective antibody

Hepatitis Virus
Morphology
Type
Particle,
nm

Genome*

HCV

9.4-kb
Hepacivirus
RNA,
linear, ss, +

Approx.
4060

Enveloped

Classification

Antigen(s) Antibodies Remarks

HCV

Anti-HCV Bloodborne agent, formerly labeled

non-A, non-B hepatitis

C100-3
Acute diagnosis: anti-HCV (C33c,
C22-3, NS5), HCV RNA

C33c

Chronic diagnosis: anti-HCV

(C100-3, C33c, C22-3, NS5) and
HCV RNA; cytoplasmic location in
hepatocytes

C22-3
NS5

HDV

3537

Enveloped hybrid
particle with
HBsAg coat and
HDV core

1.7-kb
Resembles
HBsAg
RNA,
viroids and plant
circular, ss, satellite viruses HDV

antigen

Anti-HBs

Defective RNA virus, requires

helper function of HBV
Anti-HDV (hepadnaviruses); HDV antigen
present in hepatocyte nucleus
Diagnosis: anti-HDV, HDV RNA;
HBV/HDV coinfectionIgM antiHBc and anti-HDV; HDV
superinfectionIgG anti-HBc and
anti-HDV

Hepatitis Virus
Morphology
Type
Particle,
nm

Genome*

HEV

7.6-kb
Hepevirus
RNA,
linear, ss, +

3234

Nonenveloped
icosahedral

Classification

Antigen(s) Antibodies Remarks

HEV
antigen

Anti-HEV Agent of enterically transmitted

hepatitis; rare in USA; occurs in
Asia, Mediterranean countries,
Central America
Diagnosis: IgM/IgG anti-HEV
(assays not routinely available);
virus in stool, bile, hepatocyte
cytoplasm

Harrison's
PRINCIPLES OF INTERNAL MEDICINE
Eighteenth Edition